Abstract T MP85: Does Pre-Stroke Disability Affect Acute Evaluation, Treatment and Outcomes After Stroke?
Background: Pre-stroke disability is expected to influence outcome in stroke. Enrollment of clinical trials in stroke is frequently limited to patients with pre-stroke modified Rankin score (mRS) of ≤2. Our objective is to explore evaluation, treatment and outcomes in stroke patients with pre-stroke mRS 3-5.
Methods: We included all patients from the acute stroke code database (UCSD SPOTRIAS from Mar 2005 - Jul 2013 with known pre-stroke mRS, baseline NIHSS and 90-day mRS and confirmed diagnoses: Acute ischemic stroke (AIS), transient ischemic attack (TIA), intracerebral hemorrhage (ICH). We assessed onset time to arrival, arrival time to- (CT, exam, treatment, decision) and outcomes (90-day mRS, discharge destination) by pre-stroke disability stratified by mRS (Group 1: mRS 3-5, Group 2: mRS 0-2). Good outcome was defined as discharge to home or acute rehab, or return to pre-stroke mRS or better.
Results: A total of 572 patients with AIS (416, 73%), TIA (133, 23%), and ICH (23, 4%) were identified. Group 1patients with pre-stroke mRS 3-5 (69, 12%) were older (mean ± SD: 80 ±11 versus 68 ± 7 y, p<0.001), mostly women (70% vs. 41%, p<0.001), had history of hypertension (84% vs. 71%, p=0.029), prior cerebrovascular disease (43% vs. 28%, p=0.012), neuropsychiatric disease (23% vs. 6%, p<0.001), other CNS disease (35% vs. 6%, p<0.001), and higher baseline NIHSS (mean ± SD: 14.9 ± 9 vs. 6.4 ± 8, p<0.001) compared to Group 2. Majority (61%) of Group 1 had a mRS score of 3 followed by mRS 4 (38%). There were no differences in onset to arrival, arrival time to- stroke code initiation, neuro exam, CT imaging, and treatment decision between groups. No difference in stroke patients eligible for IV thrombolysis (44% vs. 36%, p=0.23) or treated with IV r-tPA. Discharge to home or acute rehab was less frequent in ischemic stroke patients of Group 1 (44% vs. 77%, p<0.001). However, patients returning to a pre-stroke mRS score or better at 90 days was not different between groups (40% vs. 47%, p=0.39). Conclusions: Using return to baseline as good outcome measure demonstrated patients with pre-stroke disability benefit from acute evaluation and treatment. Patients with pre-stroke moderate disability (mRS 3) may particularly be considered for inclusion in future clinical trials.
Author Disclosures: N.A. Herial: None. R. Raman: None. K. Ernstrom: None. K. Rapp: None. K.H. Schlick: None. R. Modir: None. D.M. Meyer: Speakers' Bureau; Modest; Cornerstone. B.C. Meyer: Research Grant; Modest; PI, SPOTRIAS NIH Grant. Speakers' Bureau; Modest; Genentech. T.M. Hemmen: Research Grant; Modest; NIH Grant NS044148, Genentech. Consultant/Advisory Board; Modest; Merck, Co., Boehringer Ingelheim.
- © 2014 by American Heart Association, Inc.